Cedars-Sinai Medical Center decrease unimportant care using EHR alerts

Cedars-Sinai Medical Center in Los Angeles has reduced unsuitable or unimportant care by integrating recommendations from the national Choosing Wisely initiative into its electronic health record (EHR) system.

Due to the integration, EHR alerts pop up on computer screens of physicians during sufferer visits at the 958-bed hospital and multi-specialty academic health science center, advising whether specific care choices are important because of patients’ specific medical conditions and medications.

Launched in the year of 2012 by the American Board of Internal Medicine Foundation and Consumer Reports, the Choosing Wisely initiative is based on guidance from dozens of medical specialty societies and has recognized almost 500 common diagnostic tests and processes that might not have clear benefit for patients and sometimes should be ignored.

In accordance to Scott Weingarten, MD, chief clinical transformation officer, Cedars-Sinai Medical Center started integrating Choosing Wisely suggestions into its Epic EHR in October 2013, giving doctors real-time information and sparking important conversations with sufferers about the appropriateness of certain tests and treatments.

“The learning effect or educational effect is that when physicians learn Choosing Wisely suggestions, they commonly don’t re-order the unnecessary test or treatment and then cancel, but instead they don’t order to begin with, once they recognize it is not important,” claims Weingarten.

To date, nearly 100 Choosing Wisely recommendations have been added to Cedars-Sinai’s EHR system, he points out, with sufferers of physicians who followed all the alerts experiencing fewer medical complications and leaving the hospital sooner.

“After decades of discussion and debate, physicians, nurses and others responsible for delivering care at the bedside are indicating that we can deal this issue of inappropriate care where the harms exceed the benefits,” states Weingarten. “By boosting sufferers and doctors, we can deliver higher quality care more efficiently, increasing the value of healthcare for those who require it most.”

Weingarten adds that when physicians completely adhered to all the EHR alerts, costs at Cedars-Sinai Medical Center reduced by hundreds of dollars per patient encounter. Overall, the health system ignored $6 million in healthcare spending in the first full year of Choosing Wisely implementation.

“The past year, Cedars-Sinai Health System acquired $1.63 million in savings from cancelled orders alone, where physicians didn’t re-order the unimportant test or treatment or substitute another unnecessary test or treatment,” in accordance to Weingarten. “This doesn’t involve extra savings from orders not placed, decreased labor costs like nursing time linked with inappropriate blood transfusions, or the cost associated with harm.”

Among the Choosing Wisely recommendations adopted by doctors at Cedars-Sinai Medical Center is to ignore prescribing benzodiazepines, like Ambien and Valium, in the elderly. “They can cause elderly sufferers to have falls and hip fractures,” claims Weingarten.

Harry Sax, MD, professor and executive vice chair of surgery, refers to a forthcoming study of inpatient care at Cedars-Sinai conducted with Advisory Board, a healthcare consulting and research firm.

“Our research recommends that sufferers of physicians who follow clinical decision support Choosing Wisely guidelines have fewer complications, lower costs and a shorter length of stay,” asserts Sax, who advises doctors on best medical practices at Cedars-Sinai. “Future work will concentrate on the characteristics of these physicians and which alerts have the greatest effects.”

Going forward, Weingarten says Cedars-Sinai Medical Center will continue to leverage such clinical decision support to make better the quality, safety and worth of care at the health system.